The decline in adolescent pregnancy rates noted in the 1990s has been attributed to more teenagers choosing abstinence, the availability of long-acting contraceptive options, and the increased use of condoms. Many adolescents remain at risk of unplanned pregnancy, however, because of method failure, inconsistent or incorrect use, or discontinuation of a method without choosing another method. Practitioners who care for adolescents and young women have access to several new methods in 2003. Recent additions include a contraceptive transdermal patch, a hormone-releasing intravaginal ring, new formulations of pills, and a new intrauterine device. Additionally, the World Health Organization has updated its guidelines to provide the practitioner with evidence-based recommendations to assist in selecting the most appropriate contraceptive method for each patient.
Abbreviations:BMI body mass index, E2C estradiol cypionate, EE ethinyl estradiol, LNS-IUS levonorgestrel-releasing intrauterine system, MPA medroxyprogesterone acetate, WHO World Health Organization
In the United States, the rate of births among adolescent mothers declined significantly throughout the 1990s, from 62.1 births per 1000 women 15 to 19 years old in 1991 to 48.5 births per 1000 in 2000 [1,2]. Similarly, rates of sexual intercourse among adolescents declined through the 1990s into the 2000s. Among 9th to 12th grade high school students surveyed in the 2001 Youth Risk Behavior Surveillance, 42.9% of females and 48.5% of males reported ever having had intercourse [3]. Among girls, 29.1% of 9th graders and 60.1% of 12th graders report ever having had sexual intercourse. Among boys, 40.5% of 9th graders and 60.5% of 12th graders report ever having had sexual intercourse. Eighty-six percent of students are considered to have responsible sexual behavior (never had sexual intercourse, no sexual intercourse in past 3 months, or sexual intercourse in past 3 months and used a condom). Fifty-eight percent of currently sexually active students used condoms at last sexual intercourse, and 21% of girls used the oral contraceptive pill.
The decline in pregnancy rates noted in the 1990s has been attributed to more adolescents choosing abstinence, the availability of long-acting contraceptive options, and the increased use of condoms. Many adolescents remain at risk of unplanned pregnancy, however, because of method failure, inconsistent or incorrect use, or discontinuation without using another method [1]. The end result is that 13% of all U.S. births are to adolescent mothers and 25% of adolescent mothers have a second child within 2 years. Adolescent mothers may fail to complete high school and are less likely to go on to college. Only one third of pregnant adolescents receive inadequate prenatal care [4].
Education and counseling of adolescent girls about abstinence, birth control methods, and sexually transmitted disease prevention are essential. Working with adolescent girls to use birth control effectively can be a challenge because of compliance, side effects, and myths about side effects. However, practitioners who care for adolescents and young women have several new methods to offer that may help increase compliance. Recent additions include a contraceptive transdermal patch, a hormone-releasing intravaginal ring, new formulations of pills, and a new intrauterine device. Additionally, the World Health Organization (WHO) has updated its guidelines to provide the practitioner with evidence-based recommendations to assist in selecting the most appropriate contraceptive method for each patient.